Vaginal relaxation is the loss of the optimum structural architecture of the vagina. This process is generally associated with natural aging and childbirth, whether vaginal or not. Multiple pregnancies increase the alteration of these structures. During the vaginal relaxation process, the vaginal muscles become relaxed with poor tone, strength, control and support. The internal and external vaginal diameters can greatly increase with significant stretching of vaginal walls.
Recently new modalities for treatment of aged vaginal walls have been introduced, based on skin resurfacing and skin tightening methods, both ablative and non-ablative. The goal of vaginal rejuvenation is to induce tightening and promote new collagen regeneration.
In ablative procedures, the upper layer of the skin is either fully removed (bulk removal) or partially removed (fractional treatment).
Lasers commonly used for ablative removal are CO2 laser (wavelength of 10.6 μm) or Er:YAG laser (erbium-doped yttrium aluminum garnet) (wavelength of 2.94 μm), both of which have strong water absorption. Other lasers have been proposed, such as Tm:YAG (wavelength of 2.0 μm), Ho:YAG (wavelength of 2.1 μm), and Er,Cr:YSGG (erbium, chromium-doped yttrium scandium gallium garnet) (wavelength of 2.78 or 2.79 μm).
Different methods have been proposed for non-ablative procedures. For example, ablative lasers (like CO2 or Er:YAG) are used in a long pulse mode below the ablation threshold, so as to cause thermal effects due to conduction of the heat to the tissue but without ablation of the tissue. Other lasers have been used with a non-ablative wavelength with low water or blood absorption so that the effect is purely thermal and non-ablative.
Laser energy is applied to the vaginal walls through an opening in a tube which is inserted in the vagina. The tube is rotated so that the laser energy exits the opening at intervals of 90° or other angular interval; the tube is then moved proximally back (about 1 cm) and the procedure is repeated until the length of the vagina is covered. The procedure can be done multiple times in the same session.
In all laser technologies, in order to be effective, the laser beam must be focused on the vagina wall. However, focusing is often impossible since the vaginal wall is not straight or smooth; rather it contains many wrinkles.
Other methods include heating by means of ultrasonic energy or RF energy (bipolar or monopolar) at different RF frequencies, between 0.5-40 MHz. However, in RF treatment, the RF electrodes must be in tight contact with the vagina wall so that RF impedance closely matches the tissue so that the RF energy is not reflected back. This is difficult to achieve and may cause discomfort to the patient. The procedure time is disadvantageously long in order to be effective.